tion. He presented with a dark blue/grey patch involving the
right suborbital area. The etiology of his infraorbital pigmentation
was diagnosed as PIH. His first line treatment was two
treatments with fractional photothermolysis with 1550-nm
fractionated erbium-doped fiber laser (Fraxel Restore, Solta
Medical, Haywood, CA). This was followed by four weeks
of once nightly application of triple combination bleaching
agent containing Fluocinolone acetonide 0.01% , 4% Hydroquinone,
.05% Tretinoin (Triluma, Galderma, Houston Texas).
DISCUSSION
Treatment Options
POH remains a complex entity. While we have excellent randomized
controlled studies looking at treatments for periorbital
rejuvenation primarily for the elimination of rhytids and facial
hyperpigmentation; there is a lack of evidence based studies for
the treatment of POH. We do have excellent case reports, use
studies, large global patient studies and anecdote to guide us in
making safe and efficacious clinical treatment plans.
CONCLUSION
Periorbital Hypermelanosis is a complex entity with a multifactoral
etiology and an expanding knowledge base. It is
most often observed in darker races and may be considered
to be normal variants of pigmentation. There is most likely a familial component as it may be seen in family members over
generations. Though patients are distressed and usually seek
medical attention because of their appearance it is not strictly
a cosmetic issue and may be a sign for underlying health issues.
POH has specific histology and may be a final common
clinical pathway of dermatitis, allergy, sleep disturbances or
nutritional deficiences that lend itself to medical, surgical and
cosmeceutical treatments. A complete medical history with
ROS and Physical Examination is encouraged prior to treating
the aesthetic component. Sun protection is a cornerstone
of therapy. Cosmetic camouflage may be used during treatment.
Procedural and surgical treatments may improve the
appearance of POH. Safety issues are of utmost concern when
embarking upon treatments such as chemical peeling, filler
injection, and laser therapy as not to worsen the pigmentation.
Without intervention POH usually progresses over time
so early intervention and management is encouraged.
DISCLOSURES
The author has not disclosed any relevant conflicts. Wendy E.
Roberts is a consultant/speaker/advisor for the following companies
for Allergan, Kythera, La Roche Posay, L’Oreal, MelaScience,
Neostrata, SkinMedica, Top MD, Theraplex, and Valeant.
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